A case control study to assess heart carotid pulse wave velocity and pulse transit time in triple vessel disease when compared to individuals without coronary artery disease.

Introduction: Coronary heart disease (CAD) is the leading cause of morbidity and mortality worldwide, with India being the top cause. The Asian subcontinent accounts for 20% of the world's population, but 60% of the cardiovascular disease burden is due to genetic predisposition and environmental factors. Arterial stiffness increases with aging, accelerated by cardiovascular risk factors like hypertension and diabetes. Endothelial dysfunction in coronary arteries affects arterial stiffness and potentially reversible in atherogenesis. Pressure wave velocity (PWV) is a useful index for assessing endothelial status and large artery stiffness. Large artery stiffening can increase systolic blood pressure, left ventricular afterload, and left ventricular hypertrophy, potentially limiting coronary perfusion. Material and Methods: A prospective cross-sectional study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research Centre in Bangalore, India, from 1/6/2018 to 31/01/2019. Thirty patients with triple vessel disease and 30 age-matched controls underwent angiography at the institute. Echocardiography and Doppler evaluation assessed heart carotid pulse wave velocity and transit time. The study included patients with triple vessel disease and normal epicardial coronary arteries. The study excluded patients over 70 years old, having a heart rate above 100, having severe LV dysfunction below 30%, having chronic kidney disease, or having coronary artery stenosis. Demographic details, family history, medical history, clinical presentation, diagnostic tests, and blood tests were collected from patients. The study used descriptive and inferential statistical analysis, with continuous measurements presented as Mean ± SD and categorical measurements as Number (%). Results: The study involved 30 cases and 30 controls, with the majority of patients aged 50-70 years and controls aged 40-60 years. The gender distribution was predominantly males. Diagnosis distribution was similar between the two groups, with patients with EA, UA, or TMT positive being more likely to undergo angiography. BMI (kg/m2) distribution was similar between the two groups, with the majority of patients still overweight or obese but having normal BMIs. Pulse transit time (PTT) was significantly lower in the triple vessel disease case group compared to the control group with normal coronary angiography. Pulse wave velocity (PWV) increased in the case group compared to the control group. In contrast to the control group, 66% of the patients in the case group showed some kind of LV dysfunction due to more patients with myocardial infarction. Pulse wave velocity was significantly lower in the case group, with 20% and 63% shorter. LMCA distribution was also similar between the two groups, with patients with LMCA having lower pulse transit time (20%) and (63% shorter) compared to the control group. The study highlights the importance of assessing patients' angiography and LMCA distribution in determining the appropriate treatment for patients with LV dysfunction. Conclusion: Aortic PWV predicts future cardiovascular risk by accounting for known risk variables. It could be a valuable biomarker for intermediate risk, but randomized controlled studies are needed to prove its therapeutic utility before implementation. [ABSTRACT FROM AUTHOR]